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Medicare Advantage Plans

Frequently Asked Questions

What is Original Medicare?

Medicare is a federal health insurance program for people 65 years old or older, certain disabled people younger than 65, and people with End-Stage Renal Disease.

How does Medicare work?

Medicare has four parts:

  • Medicare Part A is hospital insurance that helps pay for inpatient hospital stays, rehabilitative nursing facilities, home health care, and hospice. You likely will not have to pay a premium for Part A, because you prepaid the premium through payroll taxes while you were working. You are generally automatically enrolled in Medicare hospital insurance (Part A) without a premium, when you apply for Social Security benefits – usually upon reaching 65 years of age, or after receiving disability payments for two years and if you have 10 years of creditable employment.

  • Medicare Part B is medical insurance that helps pay for doctors' services and outpatient care. You will pay a monthly premium for Part B. If you do not sign up for Part B when you become eligible at age 65, or when you have been disabled for two years and you decide you need to join in the future, you may have to pay a penalty for each year you were eligible but do not enroll. You are responsible for paying the Part B premium that is usually deducted from your Social Security benefits. Medicare pays for many healthcare services and supplies, but not all of your healthcare costs. For example, you pay a deductible for each hospital stay and may pay coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement plan.

  • Medicare Part C is the Medicare Advantage program. With this option, you can choose to have your Medicare Parts A and B provided by a private insurance company like CarePlus. A Medicare Advantage plan provides Part A and Part B coverage – and generally, additional benefits, which may include Part D coverage.

  • Medicare Part D is prescription drug coverage. If you do not enroll in Part D when you become eligible you may have to pay a penalty when you enroll.

What is Medicare Advantage?

Medicare Advantage is a type of health plan that lets you get your Original Medicare benefits from a private insurance company. The Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003 created Medicare Advantage. Some examples of Medicare Advantage plans are:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-for-Service (PFFS) plans
  1. Medicare Advantage plans often provide additional benefits not found in Original Medicare, including reduced cost-sharing, prescription drug coverage, and wellness or fitness programs. If you select a Medicare Advantage plan, you use it instead of your Original Medicare coverage. However, you can return to Original Medicare in the future if you wish.

What is a Medicare Advantage HMO?

An HMO features specific lists of in-network doctors, hospitals, and other providers that you must use to receive benefits. You generally must get your care and services from providers in the plan's network, except for emergency care, out-of-area urgent care, and out-of-area dialysis. In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.

What is the Medicare Part D drug benefit?

Anyone entitled to Medicare Part A or enrolled in Medicare Part B, regardless of income, is eligible to enroll in Medicare Part D, which is a prescription drug benefit plan. This benefit was designed to help Medicare consumers access and pay for prescription drugs. Most CarePlus Medicare Advantage plans include Part D prescription drug coverage in addition to hospital and medical coverage.

What is a Prescription Drug Plan (PDP)?

A PDP is a private, stand-alone plan (PDP) that only offers coverage for prescription medications, (Part D coverage). You can use this plan with Original Medicare or with a Medigap plan. CarePlus does not offer a stand-alone prescription drug plan. Prescription drug coverage is included in most of our Medicare Advantage plans. All Medicare Advantage plans also include Part A hospital coverage and Part B medical coverage.

You cannot enroll in more than one PDP at the same time, or in a PDP and a Medicare Advantage plan that includes prescription drug coverage (MAPD). Exceptions include Medicare Advantage PFFS plans that do not offer the Part D benefit, a Medicare Savings Account (MSA), or exceptions provided under CMS waiver authority.

If you are considering a PDP, please keep the following in mind:

  • Optional plan. A PDP is an option – not a requirement. However, if you don't join a Medicare Advantage plan with prescription drug coverage, or have a prescription drug plan (PDP) as good as a plan you can get through Medicare, you won’t have coverage for your prescription drugs and will have to pay a higher premium if you join later.
  • Monthly premium. All CarePlus Medicare Advantage plans offer medical and prescription drug coverage together for one monthly premium. PDPs, on the other hand, have a monthly premium just for prescription drug coverage. In addition to the plan premium, you must continue to pay your Medicare Part B premium, unless the state Medicaid program pays your Part B premium for you.
  • How does a PDP plan work with a Medicare Advantage plan? If you are enrolled in a CarePlus Medicare Advantage plan, it often includes prescription drug coverage, in which case you do not need to choose a PDP. Getting a PDP if you are enrolled in a Medicare Advantage plan with Prescription Drug coverage would disenroll you from your Medicare Advantage coverage.

What is the difference between a preferred cost-share and standard cost-share pharmacy?

Preferred cost-share pharmacies provide prescriptions at a lower cost-share (e.g., copayments) than standard cost-share pharmacies.

Standard cost-share pharmacies provide prescriptions at a higher cost-share (e.g., copayments) than preferred cost-share pharmacies.

What questions should I consider when choosing a Medicare health plan?

Before you select a plan, carefully consider the following questions:

  • Do you have a doctor you like?
  • Are you choosing a new doctor?
  • Do you want the ability to go to any doctor and any hospital?
  • What are your current or previous health conditions?
  • Do you need prescription drug coverage?
  • What prescription drugs are you currently taking?
  • Does the plan's formulary (drug list) include the prescription drugs you take?

When can I enroll in a Medicare Advantage (MA) plan?

If you recently became eligible for Medicare, through age or disability, you generally have the option to apply for coverage in a Medicare Advantage plan close to the date when your Medicare Part A and Part B coverage starts.

Your Medicare Advantage plan cannot start before both your Part A and Part B coverage begins. However, you generally have a period of seven months to apply for Medicare Advantage plan coverage.

This means you can apply for a Medicare Advantage plan three months before, the month of, or three months after your Medicare Part A and Part B coverage starts. You must be enrolled in Medicare Part A and in Medicare Part B. This period is known as the Initial Coverage Election Period (ICEP).

Already enrolled in Medicare?

If you did not recently become eligible for Medicare, your enrollment options are different and may be limited to certain times during the year.

Annual Enrollment Period (AEP): October 15 - December 7

During this time, you may change or enroll in a Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), or prescription drug plan (PDP), or return to Original Medicare. Changes made during this period will take effect on January 1 of the following year.

Open Enrollment Period (OEP): January 1 - March 31

If you enrolled in a Medicare Advantage plan, you can switch plans or return to Original Medicare during this time. You can change plans only one time during this enrollment period.

Special Enrollment Period (SEP)

In certain situations, outside of the ICEP or AEP, Medicare beneficiaries may be able to join, switch, or leave a Medicare Advantage plan or a prescription drug plan during a Special Enrollment Period (SEP).

Some examples of special enrollment situations are:

  • Your current plan is renewing its contract with the Centers for Medicare & Medicaid Services (CMS).
  • You recently moved to the plan coverage area.
  • You have Medicare and Medicaid.
  • You are disenrolling from an Employer’s or Union’s health coverage.
  • You want to enroll in a plan that received a 5-star rating from Medicare for that plan year.
  • You enter, reside in, or leave a long-term care facility.
  • You qualify for Extra Help.
  • You involuntarily lost creditable prescription drug coverage.
  • Other exceptional conditions may exist, as determined by CMS.

Where can I get more information about Medicare Advantage and prescription drug plans, Medical Assistance, and my Social Security benefits?

For more information about Medicare Advantage or Prescription Drug plans you can call the Centers for Medicare & Medicaid Services (CMS), or go online:

Centers for Medicare & Medicaid Services (CMS)

Website: www.Medicare.gov (link opens in new window) 

1-800-633-4227

TTY: 1-877-486-2048

24 hours a day, 7 days a week

For more information about Medical Assistance through the state, you can contact Florida Medicaid or call your State Health Insurance Assistance Program (SHINE).

Florida Medicaid (Agency for Health Care Administration)

Website: www.ahca.myflorida.com (link opens in new window) 

1-888-419-3456

TDD: 1-800-955-8771

Address: 2727 Mahan Drive, Mail Stop 33

Tallahassee, FL 32308

Monday - Friday, 8 a.m. to 5 p.m.

SHINE (Florida SHIP-SMP)

Department of Elder Affairs

Website: www.FloridaShine.org (link opens in new window) 

1-800-963-5337

TTY/TDD: 1-800-955-8770

Fax: 1-850-414-2150

Address: 4040 Esplanade Way, Suite 270

Tallahassee, FL 32399-7000

Monday - Friday, 8 a.m. to 5 p.m.

Email: information@elderaffairs.org

For more information about Social Security or Railroad Retirement earnings, call or go online:

Social Security Administration (SSA)

Website: www.SSA.gov (link opens in new window) 

1-800-772-1213

TTY: 1-800-325-0778

Monday - Friday, 8 a.m. to 7 p.m.

(Generally, you’ll have a shorter wait time if you call Wednesday through Friday, before 10 a.m. or after 3 p.m during the second half of the month)

www.ssa.gov/agency/contact/phone.html (link opens in new window) 

U.S. Railroad Retirement Board

Website: www.rrb.gov (link opens in new window)

1-877-772-5772

TTY: 1-312-751-4701

9 a.m. to 3:30 p.m. on Monday, Tuesday, Thursdays, and Friday

9 a.m. to noon on Wednesday

Address: 844 North Rush Street

Chicago IL, 60611-1275

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